A Spoonful of Sugar

A doctor I work with asked if I had done a blog about giving patients bad news. She said it was on her mind lately. She had to tell someone they had a life-threatening illness and the experience kind of shook her up. "I've given bad news before," she told me. "But the older I get, the harder it becomes. Isn't that strange?"

She told me her mentor was a terrific communicator, and that she learned a lot from just watching him interact with his patients. We sat down and I asked her to give me a rough list of things she felt were important regarding the topic. Here is what she came up with:

1. Quiet room - Make sure the place where you talk to the patient is relatively quiet and safe from interruption. Turn off your phone or beeper. Give them your full attention.


2. What do they know? - It's always good to get a handle on what the patient is thinking before providing any in-depth explanation. Sometimes their point of view is colored by false information that can easily be dispensed with at the start. You need to ask.


3. What do they want to know? - Sometimes a patient wants everything spelled out in detail, and sometimes not. Try to ascertain how much you need to say, and be mindful of their comfort level. Often, they want a family member present to verify and confirm information. Be open to their needs.


4. Keep it simple - Remember that your patient didn't go to medical school, and talk to them in a direct, but simple manner that lays out the facts without overwhelming them.


5. Listen - Give the patient time to react. Don't force the issue. Let it sink in. Let them ask whatever questions come to mind. Just...listen.


6. Conclude firmly - Don't make the patient feel rushed. After you lay out the treatment options and have exhausted their curiosity, reassure them that you will be there in the future. Some doctors give out their personal cell phone number, but we have a policy against that in our practice. What we do offer is to have a staff member follow up with a phone call in a day or two. Patients appreciate the extra effort.

I thanked the doctor for sharing her insight, and she confided that her recent experience with giving bad news had gone poorly. The patient became aggressive and started blaming his family for his problems. "I had to remember that he was distraught," she said. "And that we were on the same side."

Apparently, she let him rant for a few minutes, and he finally relaxed and admitted that it didn't matter. What was important was how they were going to move forward. Sometimes patience is rewarded.

I'm sure many of you have an opinion about this. If you'd like to share your perspective in the comments, I'd welcome it. Thanks.